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A CAREER AS A
MARRIAGE AND
FAMILY THERAPIST
Institute Research Number 869
ISBN 1-58511-869-9
O*Net SOC Code 21-1013.00
A CAREER AS A
MARRIAGE AND FAMILY
THERAPIST
Mental Health Professionals Who Assess and Treat
Couples, Families and Individuals
MARRIAGE AND FAMILY THERAPISTS ARE TRAINED TO HELP FAMILIES, COUPLES AND
individuals – at all ages and from all walks of life – confront and cope
with their personal problems. In a single day, they might be presented
with the following caseload:
A gay teenager and his parents, who are having a difficult time
accepting his homosexuality.
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An unhappily married couple who are trying to decide if their
marriage is worth saving.
A father, already burdened with financial difficulties, who has
recently suffered a job loss.
A young couple struggling to help their adopted daughter who
has a history of prior sexual abuse.
A blended family – with a baby on the way and four children
from prior marriages – who are stressed to the limit.
Marriage and family therapists differ from other mental health
professionals in that they practice solution-focused, family-centered
treatment. The course of treatment is generally brief and is designed
with an end in mind. Twelve sessions is the average, according to a
recent survey of therapists.
Marriage and family therapists believe that individuals and their
problems must be seen in context, and that the most important
context is the family. They address a wide range of relationship issues
within the context of the family system. Their goal is to help their
clients achieve more satisfying and productive relationships. Marriage
and family therapists also treat individuals in one-on-one sessions and,
in fact, about half of the treatment provided by marriage and family
therapists is one-on-one, with the other half divided between
marital/couple and family therapy, or a combination.
Marriage and family therapy is recognized by the US federal
government as the fifth core mental health profession, along with
psychiatrists, psychologists, social workers and psychiatric nurses.
Currently, 48 states and the District of Columbia regulate the
profession, requiring a license or certification to practice.
It takes many years of education and hard work to become a
licensed marriage and family therapist. You need, at a minimum, a
master’s degree, which requires about two or three years to complete,
after you graduate from college. Some go on to earn a doctoral
degree, which typically requires another three to five years. Moreover,
many hours of supervised clinical practice are required both during the
course of your studies and after graduation, in order to be eligible to
sit for the licensing examination.
3
The majority of marriage and family therapists eventually go into
private practice. This provides them with flexible work hours, the
freedom to be selective about their clientele, and the option to
specialize. But it also requires business and marketing skills, as well as
covering the expenses of running an office. Alternative work settings
include hospitals, hospice programs, inpatient facilities, employee
assistance programs, community mental health centers, schools, rural
clinics, business and consulting companies, health maintenance
organizations, social service agencies, prisons, universities and
research centers.
A career as a marriage and family therapist is both satisfying and
demanding, and not everyone is well suited for it. It takes a special
kind of person who can spend every day listening and responding to
people’s problems with the right mix of compassion and detachment.
Distance yourself too much and your clients won’t believe that you
really care about them; become too emotionally involved in their
problems and you’ll burn out very quickly. Read on to see if you’ve got
what it takes to make it in this field.
WHAT YOU CAN DO NOW
AFTER READING THIS REPORT, THE NEXT STEP YOU SHOULD TAKE IN EXPLORING
and preparing for this career is to visit the website of the American
Association of Marriage and Family Therapy (AAMFT) at
www.aamft.org. The AAMFT is the main professional association for
marriage and family therapists in the US, and its website is filled with
all kinds of information about this career, including a listing of
accredited educational programs.
Another way to learn more about this profession is to meet with
and interview several marriage and family therapists. To locate
professionals in your area, click on the Therapist Locator link that
appears on the AAMFT website. Type in your zip code and you will see
a listing of local marriage and family therapists nearby along with
contact information. You can ask them why they like to work in this
field and what advice they may have for you. But, of course, you will
be unable to sit in on therapy sessions due to privacy concerns.
Some therapists recommend that anybody who wants to work as
a therapist should first go into therapy themselves, mainly to work out
their own issues, but also to experience what it is like to be a client. If
this is not a viable option for you, try writing down your thoughts and
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feelings in a daily journal as a way to get in touch with your inner
struggles and to tackle any problems that you are dealing with in your
own life. While you are at it, it would be a good idea to examine
closely your motivations for wanting to work in the field of mental
health. Make sure that it’s not just to learn how to deal with the
mental wounds you sustained while growing up but that you also
genuinely want to help others.
If your school has a peer counseling program, by all means get
involved. That would provide you with valuable experience in the
mental health field. Alternatively, look for volunteer or paid work
opportunities at a university, special needs center, school, camp, teen
home, women’s shelter, or crisis hotline.
In college, be sure to take psychology and sociology courses.
While you don’t need to major in a specific field as an undergraduate,
you should contact some of the marriage and family therapy graduate
programs that you might be interested in attending to see if there are
any prerequisites. If possible, also get some research experience since
doctoral programs typically require students to conduct original
research.
Finally, be sure to explore all of the other mental health
professions as well so that you end up choosing the one that best
matches your needs and desires. This includes social work, psychology,
counseling, psychiatry, and psychiatric nursing.
5
HISTORY OF THIS CAREER
MARRIAGE AND FAMILY THERAPY IS ONE OF THE NEWER METHODS OF TREATING
psychological problems. It only started to take root back in the
mid-1950s. Historically, people with marriage and family problems
either attempted to handle their own issues or sought counsel with
clergy, lawyers or doctors, rather than with mental health
professionals.
In the first half of the 20th century, psychoanalysis and
behaviorism were the predominant psychological theories in the US.
These approaches to psychotherapy focused on individual therapy and
the patient-therapist relationship. Several factors combined to make
family therapy accepted and eventually popular during the latter half
of the 20th century. The first was the growth in the number of women
enrolled in colleges, and their demand for courses in family life
education. Another influence was the establishment of marriage
counseling. The founding of the National Council on Family Relations
in 1938, and the establishment of its journal, Marriage and Family
Living, in 1939, also affected the field. County home extension agents
began working with families in the 1920s and 1930s to help them
better understand the dynamics of their family situations.
In 1942, the American Association of Marriage Counselors (AAMC)
was formed by Ernest Groves and others. Its purpose was to help
professionals network, and to devise standards for the practice of
marriage counseling.
The 1940s saw a major focus on the study of families with a
schizophrenic member. One of the early pioneers in this area was
Theodore Lidz, who published a survey of 50 families. He found that
the majority of schizophrenics came from broken homes and/or had
seriously disturbed family relationships. Lidz later introduced the
concept of “schism,” which means the division of the family into two
antagonistic and competing groups, and “skew,” whereby one partner
in the marriage dominates the family to a strong degree as a result of
s serious personality disorder.
The events of World War II brought considerable stress to millions
of families in the US. To help meet their mental health needs, the
National Mental Health Act of 1946 was passed by Congress. Mental
health workers who aided families were eventually funded under this
act.
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The 1950s is considered to be the genesis of the family therapy
movement. Nathan Ackerman is one of the most important
personalities of this decade. In his book, The Psychodynamics of Family
Life, he urged psychiatrists to begin treating clients’ mental disorders
in light of family process dynamics.
Gregory Bateson, a researcher in California, obtained several
government grants for study and, with Jay Haley, John Weakland and
eventually Don Jackson, formulated a novel, controversial and
influential therapy of dysfunctional communication called the
double-bind. This theory states that two seemingly contradictory
messages may exist on different levels and lead to confusion, if not
schizophrenic behavior, on the part of some individuals.
Bateson left the field of family research in the early 1960s, and the
Bateson group disbanded in 1962. However, much of the work of this
original group was expanded by the Mental Research Institute (MRI),
which Don Jackson established in California in 1958. Jackson helped
lead the family therapy field away from a pathology-oriented,
individual illness concept of problems to one that was relationship
oriented.
In the late 1960s, Jay Haley joined the Child Guidance Clinic,
which was under the direction of the psychiatrist Salvador Minuchin.
Minuchin first began his work with families at the Wiltwyck School for
Boys in New York State in the early 1960s. He used his own form of
family therapy to treat urban slum families.
Founded in 1942, the American Association for Marriage and
Family Therapy (AAMFT) enjoyed a huge growth in membership in the
1970s, due in part to the recognition by the Department of Health,
Education, and Welfare in 1977, as an accrediting body for programs
granting degrees in marriage and family therapy. In 1974, the AAMFT
began publishing its own professional periodical, The Journal of
Marital & Family Therapy.
The American Family Therapy Academy (AFTA) was founded in
1977 by a small group of mental health professionals who were active
during the early years when the field of family therapy was emerging.
The AFTA has focused almost exclusively on family therapy clinical and
research issues.
7
Until the 1980s, research techniques and solid research in family
therapy were scarce. A breakthrough in research in the 1980s came
when studies indicated that certain forms of family therapy were
effective in working with families. There was also a growth in the
number of publications and periodicals in this area. Some major
publishing houses began to specialize in books on marriage and family
therapy.
In the 1980s, the profession was listed as one of the core mental
health professions eligible for mental health traineeships as part of the
Public Health Service Act. It placed the profession in the eyes of the US
federal government on the same level as psychology, psychiatry and
other professions that were all receiving federal training grants.
In the 1990s, marriage and family therapy became a more global
phenomenon, and new theories and specialty areas emerged.
Emerging theories during this time included the feminist family
therapy; the reflecting team approach; the therapeutic conversations
model; the psychoeducational model; and the internal family systems
model. In this decade, there was a redirection of the family therapy
education field from a focus on producing narrowly trained,
theory-specific clinicians to a focus on training practitioners who know
how to work with special types of families.
In the 21st century, more contemporary influences such as
managed health care are influencing the course of this profession.
Managed care is requiring marriage and family therapists to justify
their procedures before therapy may begin, and case reviewers
employed by the insurance companies are now making decisions that
had previously been made by the therapist. They are now more
constrained not only by the types of problems considered to be
reimbursable but also by the number of sessions allotted for
treatment.
In this new century, where the September 2001 terrorist
attacks and the Iraq war have disturbed the national
equilibrium, the need for marriage and family therapists may
be greater than ever. Researchers have projected some of the
more important trends that will have an impact on this
profession in the coming years. They include dealing with the
grieving process, family violence, interfacing with the legal
system, aging and end-of-life system, and religious and
spiritual issues.
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WHERE YOU MIGHT WORK
ABOUT HALF OF ALL MARRIAGE AND FAMILY THERAPISTS WORK IN PRIVATE
practice. Some work by themselves in an office that they rent or own.
Others share office space with colleagues in order to share the
overhead expenses. Therapists in private practice may choose to
specialize in certain areas, such as treating those with eating disorders;
divorce or stepfamily adjustment issues; or child behavioral problems.
About one-quarter of all marriage and family therapists work in an
organizational or agency setting. The remaining 25 percent split their
time between working in a private practice and at another job setting.
Different settings tend to service different types of client populations.
Traditional outpatient settings of community-based mental health
centers funded by county and state resources typically attract a wide
range of clients.
Outpatient settings that are hospital-based and affiliated with
either the psychiatric department of the hospital or a private
corporation also employ marriage and family therapists. These clinics
are subcontracted to provide mental health services to clients referred
from within and outside the hospital. Some charitable organizations
set up facilities to provide similar outpatient services, along with
related family services such as adoption and foster care. Also,
religiously affiliated social service organizations employ marriage and
family therapists, some of whom may practice spiritually-based
therapy.
In addition to outpatient settings, marriage and family therapists
also work in traditional hospital inpatient units. A growing trend is
toward home-based family therapy services, particularly for at-risk
families in need of short-term, high-intensity treatment.
Other settings where marriage and family therapists are employed
are residential facilities for children and adolescents with severe
behavioral and legal problems related to violent behavior, sexual
offenses or chemical dependency that require either temporary or
permanent removal from their home.
Marriage and family therapists also find employment with hospice
programs, employee assistance programs, rural clinics, and business
and consulting companies. They also work for programs affiliated with
the criminal justice system that provide required mental health services
for various offenses, such as shoplifting, domestic violence, sexual
abuse, and driving under the influence of alcohol. They can also be
9
found working in schools. There are now many grants and programs
that incorporate into schools a variety of mental health services for
children and adolescents. In fact, marriage and family therapists can
be found almost anywhere that healthcare is delivered or practiced.
Those marriage and family therapists with a doctoral degree have
additional opportunities available to them. They may work at a
university to teach and conduct research, or find employment at a
research or public policy center.
DESCRIPTION OF WORK DUTIES
WHEN AN INDIVIDUAL, COUPLE OR FAMILY SEEKS OUT THERAPY, THE FIRST TASK FOR
the marriage and family therapist is to conduct an intake session.
During the intake session, many questions are asked, and careful
listening is required. The therapist looks for signs of any mental
disorders, takes a psychosocial history, and makes a tentative
diagnosis. Immediately following the intake session, the therapist
needs to document what occurred. This information is used to develop
a preliminary treatment plan.
According to a recent survey of marriage and family therapists,
the most common presenting problems are mood disorders, couple
relationship problems, family relationship problems, anxiety disorders,
and adjustment disorders. Presenting problems are those concerns
that have motivated the client to seek treatment in the first place. Of
course, as the therapy progresses, other underlying problems will
usually be uncovered.
Marriage and family therapists typically take a systemic approach
rather than an individual approach when treating their clients. With
the idea that people do not live in a vacuum, a systemic approach sees
individuals within the context of their close relationships, and patterns
of communication and relating with others are evaluated.
A frequent challenge for marriage and family therapists is how to
get family members to participate in therapy sessions along with the
individual client. Not all family members will see the value in therapy,
or recognize that they play a role in problems that another family
member may be experiencing. Therapists use a range of strategies to
encourage other family members to participate. If they still refuse to
participate, all hope is not lost since much can be accomplished in
individual sessions. In fact, marriage and family therapists actually
spend a significant percentage of their time working with individuals
rather than directly with couples or families.
10
During the course of therapy sessions, the therapist must
challenge old perceptions, help clients define their problems, and
develop various possible solutions. The therapist needs to assess what
changes can or should be made in order to help the family function
better. They encourage clients to develop and use skills and strategies
for confronting their problems in a constructive manner. They may
push family members and the family as a whole to make changes and
breakthroughs. Asking carefully constructed questions will help clients
identify their feelings and behaviors.
Sometimes, the therapist will assign homework. As an example,
family members might be asked to practice listening to one another at
home and then each member will have to paraphrase what another
said before making his/her own statement.
Therapists spend a great deal of time documenting their work.
Documentation is not only for the benefit of the therapists and their
clients, but is also a necessary step for legal reasons and for insurance
reimbursement purposes. Self-employed therapists who accept
insurance will have to do extra work. They will need to fill out forms,
provide proper documentation and follow up on any problems that
arise. Even for those who do not accept insurance, collecting payment
can be a big job.
Notes should be written as soon as possible after each session so
that the information is fresh in the therapist’s mind. The specific
record of each session is called a case note or a progress note. Many
formats for case notes exist, and an increasing number of computer
software packages for producing complete clinical records are
becoming available. Still, it is quite a challenge to capture in words the
essence of the complex dynamics of a session.
Therapy sessions typically last 50 to 60 minutes. According to the
research on marriage and family therapy, the first few sessions are the
most critical. During these early sessions, the therapist needs to
establish a sense of trust, which is a crucial component of family
therapy.
A number of different types of therapies have been developed
over the years by various theorists, and you will learn about and study
many of them in school. Therapists may choose to specialize in one or
several techniques and treatment methods. Despite outward
appearances, however, many of these various family therapy theories
are more alike than different in practice. For instance, all kinds of
family therapies are concerned with processes involved in clarifying
11
communications among family members, overcoming resistance, and
rectifying dysfunctional behaviors. Most see the relationship and not
the individuals within the relationship, as the focus of therapy.
Consequently, marriage and family therapists have many common
concerns and procedures that transcend their different theoretical
systems.
According to a recent survey of marriage and family therapists,
the most popular theoretical approaches are cognitive-behavioral;
multi-systemic/systems; psychodynamic; Bowen family systems; and
solution focused. The most prevalent and empirically validated
treatment models for working with couples in or outside of marriage
are behavioral couple therapy (BCT), cognitive-behavioral couple
therapy (CBCT), and emotionally focused therapy.
With behavioral couple therapy, the underlying assumption is that
all behavior is learned and that people, including families, act
according to how they have been previously reinforced. Behavior is
maintained by its consequences and will continue unless more
rewarding consequences result from new behaviors. A second major
principle of this approach is that maladaptive behaviors, and not
underlying causes, should be the targets of change. A third premise is
the belief that not everyone in the family needs to be treated for
change to occur.
In cognitive-behavioral family therapy, the idea is that there are
health-promoting, relationship-related cognitions that promote
growth, and negative relationship-related cognitions that lead to
distress and conflict. Three prevalent forms of behavioral and
cognitive-behavioral family therapy are behavioral parent training,
functional family therapy, and behavioral treatment of sexual
dysfunction.
Therapy is not always smooth sailing, even for a highly
experienced therapist. Treatment impasses, or getting stuck or stalled,
can occur at any point in therapy. This is to be expected. Fortunately,
there are a number of strategies available to overcome this situation,
and most of the time it will not lead to the necessity of referring the
case to another professional or terminating treatment.
Marriage and family therapy does eventually reach a point when it
is time to end the treatment. Termination must be carried out in a
planned and systematic way, rather than in an abrupt manner. The
process of wrapping up a case successfully must begin long before you
have a final session. In fact, at the start the therapist should begin
12
with an eye towards the end, and clients should be informed that
therapy is not forever. Of course, it can be difficult to predict just how
long treatment may take, however, an honest effort must be made to
give the client a reliable estimate.
Therapists have to be very conscious of making ethical decisions.
Some common ethical concerns include the issue of confidentiality.
Confidentiality means that the information revealed during therapy
will be protected from unauthorized disclosure. A breach of
confidentiality could also cause the therapist some legal jeopardy. Of
course, a sexual or even close personal relationship between a
therapist and a client is absolutely forbidden.
There are times, however, when confidentiality cannot be
maintained – in cases of child abuse, for example, when therapists are
mandated to report such situations. As a family therapist, you might
be subpoenaed to appear before a court to testify on behalf of or
against a family or family member.
Therapists must be accepting of people whose beliefs, morals and
values may differ from their own. They will also be working with
people from diverse cultural and religious backgrounds, and therefore
it is important for therapists to examine and confront any biases they
may be harboring so that it does not affect their work.
Peer supervision and consultation are an important part of a
marriage and family therapist’s professional life. Supervision is a
requirement to obtain a degree in this field, and then to become
licensed. Supervision may also be required by the agency you work for.
Those who are self-employed may choose to continue with supervision
for guidance and a sense of security. Many go on to become approved
to do supervision for others. Along with face-to-face supervision, other
options include videotape review and case consultation.
13
THERAPISTS TELL THEIR OWN STORIES
I Am a Clinical
Supervisor at a
Nonprofit Agency and I
Have My Own Private
Practice “I’ve been working at a nonprofit
agency through the county of Los Angeles for the past eight years.
I started as an intern and eventually became a supervisor, and
then worked my way up to the director of an intake department.
Now I just do clinical supervision for students and interns.
Right now I am only working part time because I have a
young child at home. I work two days a week for a total of about
20 hours. I also have my own private practice where I see six
clients each week. When I worked in the field full time – in the
director position and doing private practice on the side – I was
making a six figure income, but I was working 65-plus hours a
week.
I have a bachelor’s degree in psychology with a minor in
sociology focusing on marriage and the family. I also have a
Master of Science degree in marital and family therapy. I went
straight from my bachelor’s degree to a master’s degree, which I
received 10 years ago. When I was in the master’s program, I
started what is called a trainee program, where I saw clients under
the supervision of a licensed professional. I had to get 500
face-to-face client hours before I could graduate. Once you’re
finished with your master’s degree in the State of California you
become an intern, and you have to gain many more hours before
you can sit for your license. Usually as an intern, it takes about two
to three years working full time in the field at low pay seeing
clients, in order to get that experience, until you can sit for your
licensing exam.
After I left graduate school, I worked in a residential
treatment facility for kids ages six to 12 with severe mental
illnesses. I was there for about a year. Then I moved on to a small
group home setting with teens who weren’t going to be adopted
but were going to go into transitional living when they turned 18.
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Now, in my private practice, I see everybody from a
four-year-old child to a geriatric client. I have a colleague who is a
child psychiatrist, and we share office space so we’re always
referring clients to each other. I’ve also marketed to the private
schools in the area because I only accept cash-paying clients. I
don’t bill insurance so I market to an affluent community that can
afford the full fee every week.
In private practice, if your client doesn’t show up you don’t
get paid but you still have the expenses of being a business owner.
Also, in private practice it’s very lonely. I have colleagues that share
my rented space but we have different hours so it’s just me and
nobody else except my clients. You have to pick up the phone and
talk to somebody if you want to consult about a case.
What I like best about this career is the flexibility. I also really
like working with my clients. I have high-functioning clients that
are struggling with typical life issues, and I find it rewarding
working with people at all different developmental stages and
ages. Then I can go to my clinic and do clinical supervision and
guide students through their training. There’s never a day that
gets boring for me.”
I Started My Own
Private Practice “My bachelor’s degree is in
chemistry, but I always loved psychology and read many books in
that area, so I eventually decided to pursue a career in therapy. I
received a master’s degree in marriage and family therapy at a
university in Connecticut.
I did my internship at an agency, and when it came time to
work to accumulate hours for my license, I was hired by that same
agency as sort of a subcontractor. They provided the supervision,
and I earned my required hours there. While working toward my
license I focused mostly on children, so two other therapists and I
eventually left to form a group practice specializing in children. We
did that for four years until one of the members retired. Then I
opened my own private practice.
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I mainly get referrals. When I was with the group practice I
was on what they call insurance panels where you’re on their list
as a provider and you get a reduced fee, but in exchange you tend
to get more volume. So in the group practice I gained clients that
way, and through referrals from psychologists, psychiatrists,
school counselors, school principals and special education people
that knew me in the community. In my own private practice I also
continued the relationships that I had built at the group practice.
I’ve done some advertising but it really hasn’t been productive.
I’ve also made speeches, and that gets my name out there and
builds awareness, but I don’t know if it builds clients. I find that
the best way to get new clients is through referrals and word of
mouth.
I work three days a week. I have two small children so I’m
doing a family balancing act. I see adults and children. I see adults
in the early afternoon or late morning starting at 11, and then I go
until 8 at night. On the days that I’m off I’m not really off because
I’m returning phone calls and emails, working on scheduling, and
working on cognitive-behavioral therapy handouts for the
children.
It’s fulfilling and gratifying to watch people grow and change,
and knowing that I am the agent of that change. I don’t tell
people what to do – I can just take people through that process.
It’s very interesting and always changing. I work with kids so it can
be fun just watching them go through the process. And it’s a very
creative career. You have to really think about different ways to
approach a problem and try what works. You cannot be rigid.”
I Use Some
Nontraditional
Therapies in My
Practice “Part of my ongoing effort is to help
people in a broader context. Let’s say a couple comes in and
they’ve had trouble communicating for years. I find out why that
is, and if it’s partly due to a person’s inability to think clearly and
therefore they can’t articulate or listen well, then I might very well
help with what’s called neurofeedback. It helps the person calm
down and clear up foggy thinking. Some people walk around in a
16
bit of a fog, and others may have had an injury to their head that
interferes with their ability to really process well and think clearly.
Or they may have attention deficit problems as adults, so I might
do neurofeedback to help them. They do become better listeners
and have better communication skills and become better spouses.
The same holds true for a child who’s having difficulty at
school or at home. Maybe the whole family needs to have help,
and I might do family therapy to help structure some of the chaos
that is going on and making it hard for the child. But I might also
do neurofeedback or biofeedback sessions with the child to help
him/her pay attention more effectively and become more
successful at home and at school, while at the same time I will
help the family structure itself better.
Another nontraditional method that I use is guided Eye
Movement Desensitization and Reprocessing, which helps people
who’ve had trauma in their past and might have some of the
symptoms of post-traumatic stress disorder creating havoc in their
lives. Eye Movement Desensitization and Reprocessing helps
people get past the emotional reactivity that they still might have
in certain situations.
I was one of the first to be licensed as a marriage and family
therapist in New York State. I was on the licensing board and was
involved in writing the regulations for licensure. I had my first
experience as a therapist working for an agency where I had an
internship doing marriage and family therapy. It wasn’t for credit
but I ended up being fascinated by the idea that I could treat
somebody and help them in a much larger context than simply as
an individual. I knew that people were coming to see me and
getting help, but then they were going back to the same
environment where they were living, which wasn’t changing, and
so I thought: What if we could change the family, including the
parents as well as the child? Or, what if we could change the
spouse as well as the partner? Indeed, I have learned to see things
much more as a whole when I look at a problem. I love to work
with couples because I know that a problem is never one sided,
and I get to hear both sides.
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Since I have a private practice, I have the flexibility to schedule
my time the way I want. However, I do need to schedule sessions
at times convenient for my clients. Because I choose to work with
families and couples, there might be some evening hours. It
always gets more complicated when you have to get more than
one person in a room because of their different schedules.
My typical workweek by my own choice is to start at 8:30 or
9, depending on the day, or maybe 10. I might have some days
where I’m busy every hour from 8:30 until 6:30. And then another
day I’ll have a lighter schedule. I don’t do very well when I have to
work a really intense schedule, one person after another, day in
and day out. What I like about my schedule is that it’s varied.
Today I had supervision this morning, where I sat down with a
psychiatrist who went over my cases with me, and that was a nice
break from doing sessions all day. Another thing I do is a radio talk
show, so I’m actually helping people that way, too.
I’ve always sought to have my office be as much like a living
room as possible – a comfortable, warm, and safe environment
where you have privacy, where people feel that what they say is
going to stay there, and that they’re not going to be judged. I
don’t like working in a cramped environment. I like order in my
office. I don’t commute very far. I have a
duplex and I see people out of one side of it.
I really like the fact that the people who come to me by and
large don’t have serious mental illnesses. What they typically have
is an adjustment disorder. There is something going on in their
lives that they are having difficulty adjusting to. I really like
teaching people how to communicate about issues that they’ve
gotten stuck on in the past, and I like to see the restoration of
some balance in a person’s life or relationship.
I believe that there will always be a market for this service so I
think that it’s a good investment in the future. I also think that
anybody who gets enough training and who has the gift of being
a good therapist can go far in this profession and make good
money. I don’t like telling people that they have to sacrifice a high
salary because they are working in a profession that has more
emotional satisfaction. I don’t like that tradeoff, because you can
go into business for yourself if you’re a good businessperson and
you can make a good living.”
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I Work Three Nights a
Week in My Own
Private Practice “I am the mother of two
young girls so besides loving therapy and wanting to do it and
work on my own, one of my main reasons for a private practice is
so I can be home with my children. During the day I stay with
them, and then my husband gets home three days out of the
week at 5:30, and on those evenings I get right in the car and go
to my office. I work three nights a week and see three clients a
night maximum. Probably what I like least about my job is that I
have to work at night. My goal is that once my children are in
school I can shift to daytime. But right now it’s just a very long
day, and I don’t like it when my family is sitting down for dinner
and I have to be walking out the door.
What I like best about my job is the rush that I feel when
people have been helped, and knowing that I’ve made a
difference. They feel happier and have the tools to know how to
help themselves. People come in with pain that is very real and
very intense, and it’s a privilege to be a witness to that and be able
to help them. It’s also a huge responsibility. It’s not something I
take lightly. It’s very, very gratifying when people tell me that they
don’t know what they would have done had they not come to
therapy, and that it really changed their lives.
I’ve known that I wanted to be a therapist of some sort since I
was fairly young. I was the kind of kid who others would talk to
about their problems. I went to college and majored in psychology
and minored in child and family studies. In fulfilling the minor I
became familiar with the marriage and family therapy department
at my university. Every course that I took in my minor fascinated
me, and it just seemed to click, and I discovered that I had a
passion for it. I didn’t really know about marriage and family
therapy until I started taking the classes, and when I did, I realized
that it was what I wanted to do.
We have more training hours required in marriage and family
work than most healthcare professions. We have to complete 500
client contact hours in the school program, and then we have to
complete another 1,000 for licensure. That also includes
supervision. To my knowledge, we have more thorough and
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complete supervision than any other profession does. Everything is
supervised. Every week included three hours of supervision while I
was an intern, and then while working toward licensure I had to
have 100 supervision hours. So you’re really closely monitored. It
was extremely helpful always having someone watching over my
shoulder. It was also a little nerve-wracking at times, but I see how
it really helped my education to be first rate. In my program we
had an in-house clinic where we interned, and clients came from
the community and received a reduced fee.
It’s a very rigorous process to become a marriage and family
therapist. When you’re in a program, you are the tool so your
trigger buttons are all going to be fair game in the pursuit of
being a good therapist. A lot of people go through the program
and it sort of cures them of the urge to do therapy. I met my
husband in the program, and he is still interested in it but it’s not
his passion and not what he ended up wanting to do. So he now
works in another field. Just be prepared to work hard, and if it is
something that you want to do then the rewards will be great.
I graduated in 1999 and got my license in 2001. When I got
my degree, I worked with an agency working with children and
families. I worked to gain hours towards licensure there. I worked
at one agency for that, and after I became licensed I worked at
another agency. As is fairly typical for the first job out of school, I
was at an agency where I was working with very high-risk
populations and working long hours and seeing many clients. The
good thing about that is you complete your hours for licensure
quickly. I started my own private practice in 2002 on a very
part-time basis. I quit my job at the agency very soon after I
started my practice and devoted my time to it all the way. I’ve
been doing it ever since.
In order to be successful in this profession you have to be
comfortable with yourself. You have to be facile with language.
It’s all about being able to communicate well. And I think you
have to be honest, because clients will pick up insincerity very, very
quickly, and that can destroy the whole process. You really have
nothing unless you have a good relationship with the clients and
they trust you and believe that you are there to help them, and
that you really care.”
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PERSONAL QUALIFICATIONS
IF YOU’RE CONSIDERING A CAREER AS A MARRIAGE AND FAMILY THERAPIST,
chances are excellent that you like interacting with people on an
emotional level and that others feel comfortable sharing their
problems with you. But what other personal qualities will you need in
order to be successful in this field?
Emotional stability is crucial. This means that you can express
compassion without allowing the problems of others to weigh you
down. You must be able to separate your feelings from those of your
clients. And, of course, you can’t bring your own problems into the
office. It is easy to get burned out in this career if you can’t
appropriately manage your own feelings and problems.
Marriage and family therapists must have exceptional
communication skills, which includes both the ability to speak well and
to listen well. Good written communication skills are also important
because you will frequently be writing notes about your sessions.
You must be nonjudgmental and accepting of people from
different backgrounds and beliefs. You have to act ethically at all times
in your professional life and can’t be rigid in your thinking. Good
analytical skills are also important.
A good therapist will not become unsettled when dealing with
ambiguity. There are usually no black-and-white answers when it
comes to mental health and there will be many times when the right
path to take is not clear. You will need to be able to accept this fact
without becoming frustrated or confused.
Other important characteristics include empathy, warmth,
trustworthiness, and the ability to set boundaries with your clients.
Successful marriage and family therapists also tend to be creative and
intuitive.
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ATTRACTIVE FEATURES OF THIS CAREER
THE PERSONAL SATISFACTION THAT GOES ALONG WITH HELPING PEOPLE IMPROVE
their relationships and better their lives is perhaps the greatest reward
of being a marriage and family therapist. It’s a great feeling to know
that you have made a real difference in the lives of others. You will
play a substantial role in keeping marriages intact, preventing suicides,
helping children succeed in school, lifting individuals out of
depression, and so much more.
Another attractive feature of this career, especially for those trying
to balance their work and home lives, is the flexibility it affords
therapists to plan their own work schedule around personal needs. It
is also appealing to have the option of either being self-employed or
working as an employee.
Through their education and work, marriage and family therapists
often develop an increased ability to solve their own family problems
and a deeper appreciation of their family. They are also able to hone
their communication skills.
Marriage and family therapists report that their days are varied
and challenging. Consequently, there is rarely a dull moment in this
profession.
UNATTRACTIVE FEATURES
WHILE CERTAINLY REWARDING, SPENDING YOUR DAYS HELPING OTHERS DEAL WITH
their problems can also be stressful and emotionally draining. It
requires skill to be able to demonstrate sympathy and compassion to
your clients while at the same time maintaining a comfortable
professional distance from them.
If you bring your clients’ problems home with you, you’re likely to
burn out at some point in your career. Setting boundaries with your
clients can also be a challenge. Some expect you to be available to
them 24 hours a day, seven days a week, but that is neither
professional nor prudent. Also, because many agencies are
understaffed, resulting in heavy caseloads for therapists, a high level
of emotional and mental energy is required to keep up with the work.
If you want to have your own private practice, you will need to be
business savvy in order to be successful. Keep in mind that with a
private practice you will have the expense of renting or purchasing
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office space and all of the overhead costs that go along with that.
Moreover, therapists in private practice often report feelings of
isolation and loneliness while at work.
The unfortunate reality is that an investment in malpractice
insurance is necessary in order to protect yourself from a client who
may want to sue you. Even if the agency or institution that you work
for has comprehensive malpractice insurance to cover its staff, it is
recommended that you still obtain your own insurance to protect
yourself in case of any loopholes.
This career requires you to spend considerable time doing
paperwork. You must keep careful records of each session. If you
accept insurance, that requires an additional layer of paperwork.
While this career offers you some flexibility in planning your
weekly schedule, you may need to work night and weekend hours to
accommodate those clients who are in school or at work during the
weekday.
EDUCATION AND TRAINING YOU WILL NEED
THERE ARE THREE EDUCATIONAL PATHS AVAILABLE TO THOSE SEEKING TO BECOME
a marriage and family therapist. Individuals may attend a master’s
degree program, a doctoral degree program, or a post-graduate
clinical training program. Whichever path you choose, you will be
trained in the diagnosis and treatment of mental disorders and learn
about human growth and development, behavioral patterns, marital
and family interaction, sexual dysfunction, parent-child relationships,
and the dynamics of family systems. You will also be taught a variety
of therapeutic techniques and processes.
Master of Arts or Master of Science programs typically require two
to three years to complete. These programs cover broad areas of
theory and practice in marriage and family therapy. Students take
clinical courses in the first year and start seeing clients during the
second semester of the first year. Students are required to complete
500 hours of supervised clinical practice.
Courses may have such titles as: introduction to marriage and
family therapy practice; system dynamics in a group setting;
introduction to family systems; couples therapy and techniques;
marriage and family therapy ethics and issues; assessment in marriage
and family therapy; introduction to cultural diversity; sexual issues for
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the helping professional; family theories in family therapy; applied
research in social work; statistical thinking; child development theory
and family therapy interventions; marriage family therapy practice in
substance abuse.
Doctoral degree programs generally require three to five years to
complete. Students need a minimum of 1,000 clinical hours providing
therapy and 200 hours of supervision to graduate with a doctoral
degree, some of which may be transferred from their master’s
programs. The doctoral program in marriage and family therapy is
designed to provide students with an understanding of advanced
theory and expertise in process and outcome research methodology.
This training provides advanced instruction in marriage and family
therapy research, theory construction and supervision. It is preparation
for teaching, research, advanced clinical practice, and supervision.
Students are trained in advanced theory, research, and teaching in the
field of marriage and family therapy.
The third educational path that can lead to a career in marriage
and family therapy is available to those who have already earned a
graduate degree in another mental health field, such as psychiatry,
psychology, clinical social work, or psychiatric nursing. They may
attend an accredited post-graduate degree clinical training program
that provides clinical education in marriage and family therapy.
Programs may provide specialized training in a particular modality or
treatment population and generally require two to four years to
complete.
The American Association for Marriage and Family Therapy’s
(AMFT) Commission on Accreditation for Marriage and Family Therapy
Education (COAMFTE) is the national accrediting body for graduate
and post-graduate educational and training programs in the field of
marriage and family therapy. For a listing of accredited programs, visit
the AAMFT website at www.aamft.org.
Currently, 48 states and the District of Columbia support and
regulate this profession by licensing or certifying marriage and family
therapists. The regulatory requirements in most states are substantially
equivalent to the American Association of Marriage and Family
Therapists Clinical Membership standards. After graduation from an
accredited program, a period, usually two years, of post-degree
supervised clinical experience is necessary before licensure or
certification. When the supervision period is completed, the therapist
can take a state licensing exam, or the national examination for
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marriage and family therapists conducted by the AAMFT Regulatory
Boards. This exam is used as a licensure requirement in most states.
You should check with the licensure board in your state for its
licensure or certification requirements.
Licensure or certification laws for marriage and family therapists
provide a mechanism for the public and third-party payers to identify
qualified practitioners. Marriage and family therapists who obtain this
license or certificate have met high educational and clinical experience
criteria. All states require a master’s or doctoral degree and supervised
clinical experience. The most common titles used for this license are
Marriage and Family Therapist or Marital and Family Therapist.
License renewal requires the completion of continuing education
credits. These can be earned by taking workshops and seminars
periodically.
EARNINGS
THE AVERAGE ANNUAL SALARY FOR MARRIAGE AND FAMILY THERAPISTS
nationwide is about $45,000. Most earn between $35,000 and
$55,000. A few earn $25,000, and some earn as much as $75,000.
Most marriage and family therapists do not work full time. The
average is 15 to 20 hours per week. Charges per session can range
from approximately $65 to $125 or more per hour. Many of those in
private practice have supplementary sources of income, such as a
part-time clinical affiliation.
Self-employed marriage and family therapists with
well-established practices usually have the highest earnings, however,
they do not receive the fringe benefits that full-time employees
typically receive.
The top paying states for this occupation are Wisconsin, New
Jersey, Oregon, Nevada, and Hawaii.
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OUTLOOK FOR THIS CAREER
EMPLOYMENT OF MARRIAGE AND FAMILY THERAPISTS IS EXPECTED TO GROW
rapidly over the coming decade. There are many reasons for this. One
is that therapy has become a widely accepted way to get help with
everyday problems, not just serious mental illnesses. Therefore, it is
becoming increasingly common for people to turn to a mental health
professional for help with relationship issues and marriage, and family
therapists are realizing the rewards of this growing enlightenment.
Health maintenance organizations (HMOs) have become
increasingly accepting of marriage and family therapists, although
they are motivated by the bottom line. Because their services generally
cost less than those of psychiatrists and psychologists, it’s not
surprising that HMOs would prefer their members to seek them out.
Another contributing factor to the optimistic outlook for
employment of marriage and family therapists in the coming years is
the proliferation of employee assistance programs. These programs
provide mental health services to employees of participating
companies, and more than half of all employee assistance programs
employ marriage and family therapists as staff members or contracted
providers.
Marriage and family therapy is also increasingly in demand
because of its relatively brief, solution-focused, family-centered
approach, and its demonstrated effectiveness. In fact, research
indicates that marriage and family therapy is at least as effective as
individual treatment for many mental health problems such as adult
schizophrenia, mood disorders, adult alcoholism and drug abuse,
children’s conduct disorders, adolescent drug abuse, anorexia in
young adult women, childhood autism, chronic physical illness in
adults and children, and marital distress and conflict.
Recognition of marriage and family therapists by the federal
government and the 48 states that require licensure or certification
has also helped this profession to grow.
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STARTING YOUR CAREER
AS A STUDENT IN A MARRIAGE AND FAMILY THERAPY PROGRAM, YOU WILL BE
required to complete many hours of clinical practice. For some
students, this can become an entry into their first job if they are lucky
enough to work at a place that is hiring, and they did an outstanding
job. Others can use the resources available at their school to make
connections, polish their résumés, and learn about job openings. You
will find that most accredited programs offer comprehensive career
guidance services.
After graduation from an accredited program, a period of usually
two years of post-degree supervised clinical experience is necessary
before you are eligible for licensure or certification in most states.
When the supervision period is completed, you may have to take a
state licensing exam conducted by The Association of Marriage and
Family Therapy Regulatory Boards (AMFTRB). Be sure to familiarize
yourself with the laws of the state where you intend to practice
regarding licensure or certification requirements.
Obtaining your license should be a primary goal as you go about
selecting your first job. To do so, you will almost certainly have to work
under a licensed professional for a period of time until you meet the
supervised experience criteria for a license in your state. You will want
to work somewhere that provides the type and scope of supervision
required by the board of the license that you are working toward.
When starting your career, turn to the professional associations,
particularly the American Association for Marriage and Family Therapy
(AAMFT). The AAMFT has a very useful Job Connection service on its
website at www.aaft.org. If you become a member of the AAMFT, you
can search for a job and post your résumé on this site.
If your goal is to have your own private practice, you first need to
get some experience at an agency or institution and try to build up a
client base as well as professional contacts. Once you have your license
and several years of experience, you are well on your way to
establishing a successful career in this field.
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ASSOCIATIONS
 American Association for Marriage and Family Therapy
www.aamft.org
 American Family Therapy Academy
www.afta.org
 International Association of Marriage and Family
Counselors
www.iamfc.com
 National Council on Family Relations
www.ncfr.com
PERIODICALS
 American Journal of Family Therapy
www.tandf.co.uk/journals/pp/01926187.html
 The Family Journal
www.iamfc.com/family_journal.htm
 Family Process
www.familyprocess.org
 Family Therapy Magazine
http://www.aamft.org/resources/Product_Events/FTMPage
/FTM_Online.asp
 Journal of Consulting and Clinical Psychology
www.apa.org/journals/ccp
 Journal of Marital & Family Therapy
www.jmft.net
 The Journal of Marriage and the Family
www.ncfr.org/journals/marriage_family/home.asp
COPYRIGHT Institute For Career Research 2009
CAREERS INTERNET DATABASE www.careers-internet.org
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